In addition to the static support provided by orthoses, the body has several muscles that, because of their anatomical positions, can either directly affect the arch or assist the posterior tibialis tendon (PTT). Performing 3 sets of 10 repetitions of these special exercises every day can strengthen the muscles to help manage PTTD.

See the end of the article for photos of the following exercises.

Arches: Sit (easier) or stand (harder) with feet and ankles together. Tie a resistive band around ankles. Separate feet hip width apart. Keeping the front and back portions of foot on the ground, lift the middle part (arch) of foot.

Big Toe Taps: Sit or stand with feet flat on the floor. Tap big toe up and down while keeping the other toes elevated. Use a resistive band to increase difficulty.

Lateral Four Toe Taps: Sit or stand with feet flat on the floor. Tap four toes up and down while keeping big toe elevated. Use a resistive band to increase difficulty.

Toe Curls: Sit or stand with feet flat on the floor. Completely curl all toes. Use a resistive band to increase difficulty.

Plantar Flexion: Sit and place a resistive band under ball of foot. Push ball of foot into band moving foot downward. Perform this exercise with the knee straight and bent to isolate both calf muscles.

Inversion: Sit and place a resistive band over inner side of foot. Push foot into band turning foot inward.

Heel Raise: Sit or stand with feet on the ground and raise heels high so that heels turn inward. Performing this exercise on one leg only or while weighted increases difficulty. Your hip joint can influence the position of your foot and ankle. Therefore, strengthening certain hip muscles can help control excessive pronation at the foot and ankle.

Hip Abduction: Anchor one end of a resistive band to an immoveable object and the other end to ankle. The band should be perpendicular to the outside of ankle. Move leg out to the side.

Hip Extension: Anchor one end of a resistive band to an immoveable object and the other end to ankle. The band should be perpendicular to the back of ankle. Move leg backward.

Hip External Rotation: Sit and anchor one end of a resistive band to an immoveable object and the other end to your ankle. The band should be perpendicular to the outside of ankle. Twist leg inward.

Monster Walk: Stand with feet together. Tie a resistive band around knees. Separate feet shoulder width apart. Bend at hips and knees keeping back straight. Push knees outward into the band so that weight is born on the outer borders of feet. Take small steps to the left and then to the right, keeping feet separated.

If conservative treatment of PTTD fails, surgery is considered to restore anatomical alignment, but reserved for the most severe cases despite the stage of PTTD. Therefore, in management of PTTD, be aggressive with non-operative methods (i.e. orthoses and exercises) and the earlier, the better!

Calf Stretch

Monster Walk

Clam

Hip External Rotation

Hip Extension

Hip Abduction

Heel Raise

Inversion

Plantar Flexion

Toe Curls

Lateral Toe Taps

Big Toe Taps

Arches

Source: Lower Extremity Review. 2012

Visit your doctor regularly and listen to your body.

If you missed them, you can read Part 1 and Part 2 of this three-part series on flat feet and PTTD.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.